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A patient from a rural background developed corneal ulceration following an insect hitting the eye. Corneal scrapings when processed for bacterial and fungal growth yielded Nigrospora, a contaminant fungus. This fungus has been quoted in literature as a common contaminant of no pathogenic significance. Herein, we describe its role as the causative agent of corneal ulcer, which has not been reported thus far.
This study analyzes and compares several social participation concepts in health education processes to practical experiences with schistosomiasis prevention measures under the Northeast Endemic Disease Control Program (Brazilian Ministry of Health/World Bank, 1987). Using qualitative methods, institutional documents and discourses were interpreted (Sucam, FNS, and Ministry of Health). A field study was also performed (using interviews with community-based health agents and the general population) in the Zona da Mata region of Pernambuco (a historically endemic area for schistosomiasis), focused in the county of Amaraji. Comparing discourses and educational practices, we found factors that explain respective points of convergence and divergence, as well as elements linked to the social and historical process of the target population which systematically limit the efficacy of such educational measures.
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Reported are the results of an analysis of a 40-year programme leading to eradication of schistosomiasis in Guangxi, China, a large, poor autonomous region of the country that had the heaviest global burden of the disease. We used historical county data and maps showing the initial distribution and density of Oncomelania snails and the initial prevalence of schistosomiasis to assess the correlation between snail occurrence and human infection. All annual county schistosomiasis reports were collected and analysed, including information on snail abundance and infection, human and animal infection control, stool examinations and patient treatments, clinical and serology examinations, skin test surveillance, patient follow-up, patient treatments, animal examinations, water supply and sanitation, and environmental modification. The findings bear witness to the laborious, systematic and scientific basis of the control programme and how it changed over the 40 years. Of note is the continual search for and treatment of cases, the killing of snails, and the permanent alteration of their habitats using mass community participation and methods adapted to local conditions. The programme has freed more than 10 million people from the risk of schistosomiasis and boosted rural economic development and health. The persistence, good record keeping, evolving and locally flexible strategies, and the clear focus of the control programme were crucial to its eventual success.
Agricultural activity occurs within many medium size towns in developing countries. Rural influences and urbanization, which may be well or poorly managed, combine to create new health problems. A geographical approach is useful for evaluating the ability of the health care system to deal efficiently with these problems. Such an approach should take into account the urban environment and human population, health care and spatial differentiation factors. Relevant health indicators were selected to analyze the geographical patterns of health risk and of the health care system. These factors were analyzed according to area, at various levels. Field studies were carried out and aerial photographs and the various available maps were also studied. Results were compared to determine whether the health care system was appropriate for the health needs of the town. Urinary schistosomiasis is a useful example for assessing the value of the suggested methodology. The risk of transmission of this disease is high so its early detection is vital. The ability of the health care system to detect infection was assessed.
The establishment of a new medical school in northern Australia, with its focus on preparing graduates to understand the health care needs of the regional population, has raised an interesting issue in problem design for teaching and assessing in an integrated curriculum. This issue is the extent to which the clinical content of a teaching or assessment problem should consider more subtle contextual issues that help to define the different roles played by rural practitioners, rather than what might be regarded as appropriate for "generic" medical education. This brief paper provides example case studies that highlight the challenge facing curriculum designers developing programs for rural clinical schools.
The Women's Reproductive Health and Development Program (WRDHP) is an ambitious attempt to operationalize two important tenets of health development thinking within a rural reproductive health context. First, it is important for communities to participate in decisions about the services and programs that affect them. Secondly, the complex nature of healthcare is best addressed by intervention processes which call for a multi-functional approach to planning and coordination. In both planning and intervention approach, the WRHDP recognizes the social, cultural and economic realities that affect women's efforts to secure the health and well-being of themselves and their families. The focus of the WRHDP is on capacity-building within a rural reproductive health environment, in this case Yunnan Province in rural China. Rather than using international donor funding to provide a specific intervention, the WRDHP used Ford Foundation funding as a lever to encourage community investment in environmental resources that affect health, to improve the technical skills of individuals within the existing health bureaucracies, and to promote structural changes within existing health and development bureaucracies to support interagency collaboration and community empowerment within the region's health and development agencies. This article describes how the WRHDP created new methods for provincial and local agencies to overcome obstacles and work with one another to improve women's health. It also describes the processes used in the rural areas of Chengjiang and Luliang counties to assess local conditions and needs, and the supported and expanded local efforts in improving woman's reproductive and family health that resulted from the processes.
OBJECTIVE: To develop, implement and evaluate a pilot program targeting rural families with preschool aged children at risk of conduct disorder. DESIGN: A prospective single group repeated measures design. SETTING: Communities in four local government areas in the Mid Western Area Health Service, New South Wales. SUBJECTS: A total of 33 families were referred to the program through community services where they were established clients. INTERVENTIONS: The Learning, Enjoying, Growing, Support model comprised a parenting program (Incredible Years; Kids Challenge and Change); a children's social skills program (Playing and learning to Socialise) and a transition to school component. Group programs were run simultaneously over 5-10 weeks. MAIN OUTCOME MEASURES: Measures of positive parenting and child problem behaviour and social skills were conducted on referral, and at completion of the program. RESULTS: There was a self-reported increase in utilisation of all positive parenting skills with significant increases in rewarding (median score on referral: 4 (range: 4-6); at completion of program 6 (4-6); (P = 0.02)) and ignoring (2 (0-6) to 3 (1-8); (P = 0.02)). Children increased their levels of social skills. Significant improvement was reported in cooperation: (median score: 24 (18-33) to 27 (19-33); (P = 0.02)); interaction (24 (6-9) to 26 (11-32); (P = 0.03)) and independence(25 (16-33) to 28 (20-33); (P = 0.008)). There was a downward trend in problem behaviour exhibited with a significant reduction in internalising behaviour (median score 19 (3-30) to 12 (0-32); (P = 0.04)). CONCLUSIONS: The positive impact of the model on parenting skills and child behaviour is promising and communities are continuing to run the programs. We recommend a broader adoption through rural communities.
"The development of the rural population in Denmark during the last 200 years is examined. Two main types of development are revealed. The types are to be attributed to differences in the basis and utilization of resources, and of industrialization and urbanization."
Government policies concerning rural settlement and rural-urban migration in Bulgaria since 1944 are evaluated and described. The author observes that during this period, "Bulgaria...has undergone rapid urbanization.... The marked destructive processes in the rural settlement network since 1944, mainly due to the ageing of the rural population and its migration to the cities, have necessitated the implementation of an active regional policy in rural regions. A 'policy of key settlements' and 'a policy of key regions' were developed in recent years [to encourage rural development]."
In a cross-sectional survey, 3746 children aged less than 6 years residing in 47 randomly selected villages of district Ambala (India), were studied to find out the environmental risk factors influencing psychosocial development. A culture appropriate test battery comprising 67 test items was administered, and psychosocial development score of each child was computed by scoring each test item passed as 1 and failed as 0. At each age level children having score in lower quartile were categorised as having slow psychosocial development and those in upper quartile were labelled as having accelerated development. Logistic regression revealed that per capita income, education of mother, nutritional status of the child, number of rooms and environmental hygiene in the house, presence of a high school within easy travel distance, availability of a caretaker when mother is busy, child attending a nursery (anganwadi), households having access to newspaper, child having toys or toy substitutes, TV, books, story telling by the mother were found to have a significant association with psychosocial development of preschool children. The risk factors identified in this survey can be used for screening families at risk in rural communities and for selection of interventions for promotion of psychosocial development of children.
OBJECTIVES: To develop a profile of rural surgeons for comparison with profiles of rural general practitioners in the light of shortages in the rural medical workforce. DESIGN: Rural surgeons were surveyed by a postal questionnaire in November 1997. PARTICIPANTS: Members of the Provincial Surgeons of Australia residing in towns with fewer than 50,000 inhabitants. RESULTS: 239 questionnaires were sent and 137 surgeons replied, a response rate of 59%. Our survey showed that rural surgeons are predominantly male, middle-aged and married. They work long hours, and nominate as their major concerns difficulty in finding locum cover, continual on-call work, peer isolation, children's schooling, and lack of privacy. CONCLUSION: Rural surgeons and general practitioners share similar characteristics and concerns.
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It is widely believed that structural variables such as inequitable land distribution, lack of rural employment opportunities, and rural-urban wage and amenity gaps influence population movements in developing countries. Yet quantitative evidence is scant. In this paper a multilevel model is used to investigate the effects of individual-, household-, and areal-level factors on rural-urban out-migration in the Ecuadorian Sierra. Data from a detailed survey carried out in 1977-1978 and from government macro-areal statistics are used to investigate factors affecting the out-migration of youths aged 12-25. Preliminary conclusions are presented on the usefulness of multilevel models in studying migration and policy implications for Ecuador.
This paper discusses the complex and interrelated roles of the rural nurse and doctor. These roles are viewed as being complementary to each other in any healthcare setting, but more so within the context of rural Australia. The current move towards the development of advanced nurse practitioner roles is often clouded by unnecessary medical fears that nurses are attempting to displace doctors. In contrast, this paper argues that the development of new rural nursing roles identifies rural nursing as a major specialist area within the wider profession of nursing and, at the same time, recognises the reality of practice for many rural nurses. Individual public figures may perceive the solution to the shortage of rural doctors to lie in their replacement with nurses. The nursing profession, however, will resist this approach. Nursing is not the first rung on the ladder to a career in medicine. Nurses are educated and acknowledged to focus their practice on the clients' responses to healthcare problems and not the practice of medicine. The primary role of the nurse is to provide care. The primacy of care should not be set aside by those nurses seeking to develop their practice, not should advanced practice be defined in terms of taking on tasks previously carried out by other healthcare professionals.
PROBLEM BEING ADDRESSED: The continuing shortage of rural family physicians in Canada. PURPOSE OF PROGRAM: To further develop training for rural family practice so that adequate numbers of rural family physicians will be appropriately prepared. MAIN COMPONENTS OF PROGRAM: All family medicine residents should have the opportunity to experience the joys and challenges of rural family practice. Rural family medicine training streams provide the best education for family medicine residents who are planning a career in rural family medicine. Integrated training for rural family practice should be high-quality, academically sound, needs-driven, evidence-based, learner-centered, and outcome-measured. This involves comprehensive development of curricula that provide specific skills and appropriate core subjects in rural practice as well as a solid family medicine foundation. contextual and experiential learning in areas similar to or in actual areas where there is a need for rural physicians, and appropriate hospital rotations to learn skills for the hospital role of many rural family doctors, are important components of rural family medicine training. CONCLUSIONS: Postgraduate rural family medicine training programs can be further focused and developed to train more physicians with the knowledge, skills, and attitudes required for rural practice.
The intake of food and nutrients differs between urban and rural areas in China. To develop a practical semi-quantitative food frequency questionnaire to cover both the urban and rural areas, we conducted diet surveys and compared food and nutrient intake between the two areas. We recruited 198 urban and 214 rural healthy inhabitants aged 35-55 years, and performed diet surveys, using a 3-day weighed dietary record approach. The intake of 29 nutrients was calculated according to actual consumption of foods, with Standard Food Composition Tables for China and Japan. Then, contribution analysis and multiple regression analysis were employed to select food items covering up to a 90% contribution and a 0.90 R2 of coefficient of determination, respectively. Consumption of energy and carbohydrates was greater in the rural area, but mean protein intake was higher in the urban case. Values for total fat were greater for rural than for urban males, with animal fat as the major contributor. We finally selected 117 and 76 food items for the urban and rural semi-quantitative food frequency questionnaires, respectively, covering 18 and 27 nutrients constituting up to 90% of the nutrient intake. Further validity and reproducibility tests are now needed to assess their appropriateness for usage.
A data-driven approach to allocating federal resources for primary care systems in rural areas is presented. This approach was developed and implemented by the Public Health Service (PHS) when it undertook its Rural Health Initiative Program. Nationally available small-area data were used to identify "priority counties" and PHS regional office staffs were asked to take an active role in developing rural health system projects in these counties. This approach was adopted to avoid the problem of the many communities eligible for and in need of funds that do not get them because they lack the organization and knowledgeable personnel required to develop a project grant application. The paper defines and discusses the "positive programming" approach (believed to be the first attempt to allocate federal health service delivery resources actively on the basis of small-area data), discusses the present shortcomings of the approach (including data limitations), and presents the results of implementing the approach. In the first year, 23% of the priority counties and 13% of the nonpriority counties were served, while in the second year 39% of the priority counties and 17% of the nonpriority counties were served. The substantial increase in the percentage of priority counties served reflects the effectiveness of the positive programming effort.